Radiology groups meet with CMS chief of staff to discuss No Surprises Act concerns
Radiology groups recently met with the Centers for Medicare & Medicaid Services Chief of Staff Rebekah Armstrong to voice concerns about the No Surprises Act.
The meeting included the American College of Radiology, billing firm Zotec Partners and Strategic Radiology, a coalition of independent imaging groups. They charge that radiologists have been forced to accept “stagnant and or lowered in-network contract rates,” ACR said in a news update published Aug. 20.
When refusing to accept underpayment, radiology groups must then use the federal arbitration process to try and negotiate “reasonable reimbursement rates,” the college said. The meeting comes after a recent high-profile report from the Wall Street Journal, claiming CMS believes physicians are “gaming” the system to score higher prices.
“Radiologists are vindicated in demonstrating providers are not the problem, evidenced by court decisions, disputed claims arbitration results, and insurers’ stronghanded actions that force radiologists out of their networks,” ACR said in its update.
During the meeting, the college said the country’s largest independent imaging group, Radiology Associates of North Texas, shared its own experiences with the NSA. RANT, as it’s called for short, has previously reported problems dealing with Blue Cross Blue Shield of Texas. The state’s largest insurer has reportedly used artificially low "qualifying payment amounts” as a starting point for conversations and refused to openly negotiate before going to arbitration.
“One large payer in Texas has continually refused to negotiate adequate in-network contract rates, forcing the practice out of network,” ACR said without specifically naming BCBS. “In the [independent dispute resolution, or IDR] process, the payer consistently declines to make reasonable market-based offers that reflect inflation or actual contracting conditions.”
Even when providers prevail in arbitration, payers are frequently failing to comply with legal requirements to pay rewards within 30 days. ACR charges that the qualifying payment mount—typically a benchmark, in-network rate for a service—is “increasingly disconnected from market reality.” RANT has previously reported receiving suggested payment amounts from Blue Cross at 21% below market.
The college echoed previous complaints that the volume of IDR submissions is not fueled by greedy physician groups, but stubborn insurers refusing to acknowledge the reality of what care costs in 2026.
“In reality, IDR volume and provider success rates are being driven by payers’ refusal to negotiate reasonable in-network rates, meaningfully participate in open negotiations, or adjust IDR offers despite a consistent pattern of physicians prevailing,” ACR added.
At the meeting, CMS leader Armstrong reportedly acknowledged limitations in the agency’s ability to enforce compliance and impose penalties. However, Armstrong emphasized addressing this issue is a “high priority issue for the agency.”
“She appreciated hearing the provider perspective and firsthand experiences,” ACR closed.
The conversation comes after an appeals court recently struck down the formula health insurers are using to calculate the qualifying payment amount. Judges now note that payers cannot use “ghost rates” that don’t reflect reality, as part of their process. ACR in a separate news update on Aug. 14 called the appeals ruling as a win for the specialty.
The college reportedly filed a “friend of the court” brief in the case, supporting plaintiff the Texas Medical Association. ACR produced the filing in concert with the American Society of Anesthesiologists and the American College of Emergency Physicians, sister societies whose members also frequently deal with surprise billing and out-of-network issues.
“ACR looks forward to CMS auditing insurers’ QPA calculations and directing them to meet the court’s ruling,” the second news update stated. “ACR will also continue advocating for Congress to enact H.R. 4710 to strengthen NSA enforcement and impose appropriate penalties on insurers that fail to comply with the law,” it added, referring to the No Surprises Act Enforcement Act.
You can read our previous coverage of the NSA and challenges providers have faced below:
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.